Winters Healthcare Foundation Patient Satisfaction- English Survey

1. How was this survey received?

How was this survey received? Winters Healthcare Foundation Website Link

Mailer Surveys (March 2010)

In the Clinic (Fall 2009)

Other

2. Your Age:

Your Age:

3. Your Sex:

Your Sex: Male

Female

4. Your Race/Ethnicity

Your Race/Ethnicity Asian

Pacific Islander

Black/African American

American Indian/Alaska Native

White (Not Hispanic or Latino)

Hispanic or Latino (All Races)

Unknown

5. Ease of getting care:

	Great	Good	OK	Fair	Poor
Ability to get in to be seen with your PREFERRED provider	*Ease of getting care: Ability to get in to be seen with your PREFERRED provider Great	Ability to get in to be seen with your PREFERRED provider Good	Ability to get in to be seen with your PREFERRED provider OK	Ability to get in to be seen with your PREFERRED provider Fair	Ability to get in to be seen with your PREFERRED provider Poor
Ability to get in to be seen with ANY provider	Ability to get in to be seen with ANY provider Great	Ability to get in to be seen with ANY provider Good	Ability to get in to be seen with ANY provider OK	Ability to get in to be seen with ANY provider Fair	Ability to get in to be seen with ANY provider Poor
Hours Winters Healthcare is open	Hours Winters Healthcare is open Great	Hours Winters Healthcare is open Good	Hours Winters Healthcare is open OK	Hours Winters Healthcare is open Fair	Hours Winters Healthcare is open Poor
Prompt response/return on calls for appointments	Prompt response/return on calls for appointments Great	Prompt response/return on calls for appointments Good	Prompt response/return on calls for appointments OK	Prompt response/return on calls for appointments Fair	Prompt response/return on calls for appointments Poor

6. Reception- Front Office Staff

	Great	Good	OK	Fair	Poor
Welcomes you promptly when you arrive	*Reception- Front Office Staff Welcomes you promptly when you arrive Great	Welcomes you promptly when you arrive Good	Welcomes you promptly when you arrive OK	Welcomes you promptly when you arrive Fair	Welcomes you promptly when you arrive Poor
Friendly and helpful to you in your preferred language	Friendly and helpful to you in your preferred language Great	Friendly and helpful to you in your preferred language Good	Friendly and helpful to you in your preferred language OK	Friendly and helpful to you in your preferred language Fair	Friendly and helpful to you in your preferred language Poor
Answers your questions	Answers your questions Great	Answers your questions Good	Answers your questions OK	Answers your questions Fair	Answers your questions Poor
How were you treated on the phone?	How were you treated on the phone? Great	How were you treated on the phone? Good	How were you treated on the phone? OK	How were you treated on the phone? Fair	How were you treated on the phone? Poor

7. Waiting

	Great	Good	OK	Fair	Poor
Time on the phone	*Waiting Time on the phone Great	Time on the phone Good	Time on the phone OK	Time on the phone Fair	Time on the phone Poor
Time in waiting room	Time in waiting room Great	Time in waiting room Good	Time in waiting room OK	Time in waiting room Fair	Time in waiting room Poor
Time in exam room	Time in exam room Great	Time in exam room Good	Time in exam room OK	Time in exam room Fair	Time in exam room Poor
Waiting for test results	Waiting for test results Great	Waiting for test results Good	Waiting for test results OK	Waiting for test results Fair	Waiting for test results Poor

8. Facility

	Great	Good	OK	Fair	Poor
Neat and clean building	*Facility Neat and clean building Great	Neat and clean building Good	Neat and clean building OK	Neat and clean building Fair	Neat and clean building Poor
Ease of finding where to go	Ease of finding where to go Great	Ease of finding where to go Good	Ease of finding where to go OK	Ease of finding where to go Fair	Ease of finding where to go Poor
Comfort and safety while waiting	Comfort and safety while waiting Great	Comfort and safety while waiting Good	Comfort and safety while waiting OK	Comfort and safety while waiting Fair	Comfort and safety while waiting Poor
Privacy	Privacy Great	Privacy Good	Privacy OK	Privacy Fair	Privacy Poor

9. Confidentiality

	Great	Good	OK	Fair	Poor
Keeping my personal information private	*Confidentiality Keeping my personal information private Great	Keeping my personal information private Good	Keeping my personal information private OK	Keeping my personal information private Fair	Keeping my personal information private Poor

10. Are you willing to wait in the clinic to see if an appointment becomes available?

Are you willing to wait in the clinic to see if an appointment becomes available? Yes

11. How long are you willing to wait?

How long are you willing to wait? 15 min

30 min

45 min

1 hr

More than 1 hr

12. If we have an opening are you willing to come to the clinic on 15 minutes notice?

If we have an opening are you willing to come to the clinic on 15 minutes notice? Yes

13. Referrals

	Great	Good	OK	Fair	Poor
The likelihood of referring your friends and relatives to us:	*Referrals The likelihood of referring your friends and relatives to us: Great	The likelihood of referring your friends and relatives to us: Good	The likelihood of referring your friends and relatives to us: OK	The likelihood of referring your friends and relatives to us: Fair	The likelihood of referring your friends and relatives to us: Poor

Winters Healthcare Foundation Patient Satisfaction- English

1. Winters Healthcare Foundation Patient Satisfaction Survey